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Real-World Study of Hepatitis C Treatment with Direct-Acting Antivirals in Patients with Drug Abuse and Opioid Agonist Therapy
Vijay Gayam1, Benjamin Tiongosn1, Amrendra Mandal1, Pavani Garlapati1, Arshpal Gill1, Smruti Mohanty2. 1Medicine, Interfaith Medical Center, Brooklyn, New York, United States, 2Gastroenterology/Hepatology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States

Purpose of Study Hepatitis C (HCV) infected patients with substance abuse face significant barriers to antiviral treatment. Limited data exist evaluating the treatment outcomes with direct-acting antivirals (DAAs) in patients with substance abuse in the community-care setting. We aim to assess the treatment response of DAAs in this subset of patients with or without the Opioid agonist therapy (OAT).
Methods Used All the HCV patients treated with DAAs between January 2016 and December 2017 in two centers were retrospectively analyzed. Patients were stratified into two groups by the presence or absence of abusing Alcohol, Cocaine, Heroin, Cannabis, and enrolled in OAT. All the patients who were assigned to the abuser group had positive urine toxicology with one of the aforementioned drugs during the DAA treatment. The primary assessment was the sustained virologic response at 12 weeks post-treatment (SVR12).
Summary of Results Among the 291 patients enrolled, 181 and 110 were patients with and without substance abuse. In the abuser group, 56 were receiving OAT. SVR12 was achieved in 95%, 94.5%, and 98% of the drug abusers, non-abusers and OAT group respectively. In multivariable logistic regression among the patients who achieved SVR12, race (OR 0.46, CI 0.23-0.89, p-<0.001), depression (OR 0.47, CI 0.25 – 0.90, p-0.02), and the HIV status (OR 0.32, CI 0.15 – 0.68, p-0.010) were significant in the abuser group. The most common adverse effect was fatigue. None of the patients discontinued the treatment due to adverse events.
Conclusions In this community-based study, DAAs are safe, effective with high overall SVR12 in patients with active substance abuse and also in OAT enrolled patients. These results support the removal of drug abuse as a barrier to DAA therapy in these patients.

Figure 1. Absolute count of the drugs screened from patients (n=181) after the toxicology screen.
Note: Among patients who screened positive: n=118 shown 1 drug; n=42 shown 2 drugs; n=17 shown 3 drugs; and n=4 patients tested positive for 4 drugs. N=110 patients screened negative for any drugs of abuse.

Table 1. Demographic and Clinical Characteristics of Patients.

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